Over the course of the Covid-19 pandemic, the US’ testing strategy has failed over and over again to provide an accurate picture of how fast and how far the disease is spreading. State and city officials are often left flying blind, not knowing how bad things are until hospital beds start filling up. The evidence of those failures is visible in the more than 180,000 Americans who’ve died so far. And if the chaos of the past week is any indication, the nation’s top public health officials are no closer to having a coordinated testing plan than they were eight months ago.
On Monday, officials from the US Centers for Disease Control quietly revised their testing guidance to advise people without symptoms to forgo testing, even if they’d been in close contact with a person who has a Covid-19 infection. Unless you are medically vulnerable, or your doctor or local public health official thinks it’s a good idea, the new guidance states, “you do not necessarily need a test.” Previously, the agency had recommended testing for anyone with a “recent known or suspected exposure” to the virus, and CDC director Robert Redfield said in an interview with NBC last month that “anyone who thinks they may be infected—independent of symptoms—should get a test.”
On Tuesday, the change became public. And by Wednesday, reports emerged that the shift had originated as a directive within the White House and the Department of Health and Human Services. Admiral Brett P. Giroir, the administration’s coronavirus testing czar, rebutted the allegations, telling reporters the changes were approved by the White House Coronavirus Task Force. One of its most prominent members, National Institute of Allergy and Infectious Diseases director Anthony Fauci, denied he was a part of any such discussions, saying in a statement to CNN that they occurred while he was undergoing surgery.
The outcry from medical professionals and public health experts was swift and furious. On Twitter, Tom Frieden, who led the CDC under former president Barack Obama, called the policy revision “unexplained, inexplicable, probably indefensible.” Governors of several large US states, including California, Texas, and New York, declared that they would not heed the new federal guidelines. “The CDC guidance not to test asymptomatic individuals who have had confirmed close contact with a Covid patient defies public health logic and can't be evidence based,” Lawrence Gostin, a health law expert at Georgetown University told WIRED in an email.
Redfield responded to the furor by backtracking. In a statement released late Wednesday on the CDC website, he said that “all close contacts of confirmed or probable Covid-19 patients” may consider testing. But by Thursday, officials at the Department of Health and Human Services were describing Redfield’s about-face as “amplifying and explaining” the guidance, rather than reversing the earlier change. And by Friday, Redfield’s statement had disappeared from the CDC’s website altogether. Agency representatives did not respond to WIRED’s questions about its removal or return a request for comment. The agency’s guidance itself has not been changed since it was updated Monday.
While it’s still unclear who’s responsible for the policy shift, it could have huge consequences. People without symptoms represent one of the biggest challenges to containing the coronavirus, because even though they don’t feel sick, they’re still just as contagious as other infected people. According to the CDC’s own analysis published in July, asymptomatic carriers of the virus are a major driving factor in the spread of Covid-19, and the reason the agency advised universal face cloth coverings back in April. The change also comes at a moment when hundreds of thousands of students are heading back to schools and universities. Many campus administrators intend to employ broad testing plans to head off outbreaks.
In fact, just this week, the CDC contradicted its own new guidance to suggest that such testing schemes have an important role to play in containing spread among students. Earlier this summer, a CDC investigation of a large outbreak at a summer camp in Georgia found that testing only prior to camper and counselor arrival had not been effective. By contrast, on Thursday, the agency published a report detailing how universal testing proved essential in keeping the coronavirus out of four summer camps in Maine. Thanks to continuous screening, the report authors found, the Maine camp administrators were able to identify asymptomatic cases and quarantine those people before they spread the disease further. “These findings have important implications for the successful implementation of Covid-19 mitigation strategies in other overnight camps, residential schools, and colleges,” the report authors wrote.
And as if you aren’t already whiplashed enough, here’s another thing: On Thursday, the White House announced that the US government had purchased 150 million rapid coronavirus tests from Abbott Laboratories. The tests, which can deliver results in 15 minutes, were granted an emergency use authorization by the FDA on Wednesday. Though the tests are so far only authorized to be used for diagnosing people with Covid-19 symptoms, the Trump administration has signaled they intend for the tests to be used more broadly. In a statement, HHS officials wrote that the Abbott tests will potentially be deployed to schools to help with regular testing. The president’s press secretary, Kayleigh McEnany, tweeted the announcement, saying that “this is a major development that will help our country to remain open, get Americans back to work, and kids back to school!”
Public health experts say it’s difficult to reconcile these two conflicting developments in the federal government’s pandemic response. “The only reason schools need that kind of rapid testing is for asymptomatic testing,” says Michael Mina, an infectious disease epidemiologist at the Harvard T. H. Chan School of Public Health. That the Trump administration would buy up rapid antigen tests to be used in a manner that’s not in line with the FDA’s emergency use authorization is confusing in and of itself, he says—let alone trying to understand the move in the midst of the CDC’s guidance change.
“All of this just demonstrates that there is no central command here. There is no plan. And it’s unfathomable that we would be eight months into this pandemic, six or seven months into it on our shores, and not have a plan in place,” Mina says. The effect of that disorganization is already being felt, he says. “We’re seeing states openly go against the guidance that our federal government is putting in place, and that’s a scary place to be in the midst of a pandemic that is killing hundreds of thousands of people.”
As of Friday, 181,050 Americans had died from Covid-19. Without more testing, more mask wearing, and better adherence to social distancing measures, researchers from the University of Washington estimate the US death toll will reach 317,000 by December. But some public health experts worry that the chaos and lack of transparency that was on display this week will make it that much harder to convince people to diligently adhere to the CDC’s guidance on other things—like wearing masks and staying away from crowded indoor places. “There’s no question public trust in the CDC has been eroded,” says Gostin.
The likely result will be a pandemic that stretches on much longer and proves far deadlier.
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